Arthritis

One of the most debilitating forms is Rheumatoid Arthritis. Rheumatoid Arthritis (RA) is an immune system disorder which causes swelling, pain and stiffness in joints. It can lead to joint deformity and may also affect other body organs. Treatment includes medicines, joint care and lifestyle changes and if started early, it can prevent or limit joint damage.

In rheumatoid arthritis, the tissue that lines the joints is attacked by the body's own immune system. Tear glands, salivary glands, blood vessels and lung and heart tissue can also be affected. The trigger for RA is unknown.

Signs and symptoms

RA commonly starts in hands, knees and feet and usually affects both sides of the body at the same time.

Symptoms vary from person to person and include:

Warm, swollen, painful joints

Joint stiffness, more noticeable in the morning

Loss of joint motion

Muscle weakness

Weight loss

Loss of appetite

Persistent tiredness and feeling ‘run down'

Rheumatoid nodules - small painless lumps under the skin

Symptoms may very from mild to severe, may move from joint to joint and may flare-up and subside. Over time damaged joints may lose their shape and alignment.

Blood tests

Rheumatoid factor - is an abnormal antibody in the blood of most people with RA.

Management

Management problems for RA aim to prevent joint damage and maintain quality of life. The main way is through diet and exercise. Some others are the use of medicines to stop disease activity and ways to reduce pain, maintain joint function and manage the tasks of daily living. Doctors, pharmacists, physiotherapists, occupational therapists and dieticians can help.

Medicines

Non-Steroidal Anti-Inflammatory Drugs (NSAID)

(e.g. aspirin, diclofenac, ibuprofen, meloxicam, naproxen) reduce joint pain, swelling and stiffness. Some can be purchased without a doctor's prescription. They must be used with care to avoid serious gatro-intesinal, heart and kidney problems.

Pain Relievers

Paracetamol may relieve pain without causing serious adverse effects. It usually needs to be taken regularly three or four times a day. Sometimes stronger morphine-like pain relievers are needed.

Fish Oils

The omega-3 fatty acids found in fish oils have anti-inflammatory effects and can reduce joint pain and stiffness and reduce the need for NSAIDs. The required dose may be taken as capsules or liquid. Ask a doctor or pharmacist for advice.

DMARDS (disease modifying and immune-modulating Anti-Rheumatic Drugs)

DMARDS slow down or stop disease activity and early treatment can prevent or limit damage to the joints and other organs. They may take weeks to months to act and must be closely monitored to avoid serious adverse effects.

Biological DMARDS

These block the actions of body proteins involved with inflammation. They must be given by injection and may improve symptoms within a few days. They must be closely monitored to avoid serious adverse effects.

Corticosteroids

The reduce inflammation and immune system activity and can quickly and dramatically improve symptoms. They can be taken orally or injected into joints. Steroids can cause serious adverse effects and are usually only used for short periods to control severe inflammation.

Pain relief

Maintain good posture to limit stress on joints and muscles

Warm towels, hot packs, or a warm bath or shower can relieve pain and stiffness

Cold packs can reduce pain and swelling

Take medicines regularly, according to directions

Rest and Joint care

Learn to recognise when your body and joints need to rest and learn ways to protect joints during daily activities. Walking sticks and splints can help protect joints. Ask an occupational therapist about splints and mechanical aids to help with daily tasks.

Exercise

Exercise regularly to improve mood, decrease pain, increase flexibility and also to strengthen muscles, bones and ligaments. Warm water exercise is especially helpful as the warmth and buoyancy of the water makes movement easier. Ask a physiotherapist for appropriate exercises.

Healthy lifestyle

Eat regular, healthy meals, including plenty of fruit, vegetables and grains. Limits foods high in fat, sugar or salt. Ask a dietician about foods containing omega-3 fatty acids that may help reduce inflammation (look at the Nutrition Centre)

Keep to a healthy weight to limit stress on joints

Don't smoke - smokers are more likely to get RA.

Asthma

Asthma is a common condition that affects approximately two million Australians. It is estimated that up to one in four children, one in seven adolescents and one in ten adults will experience symptoms of asthma at some time.

What is asthma?

People with asthma have twitchy or sensitive airways in their lungs. When exposed to certain trigger factors (something that makes a person's asthma worse), the muscles around the airways becomes red and swollen and extra mucus is secreted, resulting in narrower air passages and breathing difficulties.

What are the main symptoms?

Possible asthma symptoms include:

Coughing

Wheezing - a high pitched whistling or sighing sound on breathing

Shortness of breath

Tightness in the chest

A person with asthma may have one or more of these symptoms. The symptoms are often worse early in the morning and on waking.

What can trigger symptoms?

People with asthma may have different factors which can trigger asthma symptoms, e.g.

Your pharmacist or doctors can give advice as to how to manage these triggers.

Asthma Medications

People with asthma can lead normal, active lives if their asthma is well controlled. This can be done by avoiding exposure to trigger factors and using asthma medications which mostly come in the form of inhalers. There are four main types of asthma medications:

Preventers:

Preventers are used to prevent the redness, swelling and mucus production (inflammation) in the airways. These need to be used every day, even when there are no symptoms

Relievers:

Relievers are used to relieve the symptoms of asthma quickly be relaxing the muscles around the airways. The inhalers may be purchased from a pharmacist without a prescription. Needing a reliever more than 3-4 times a week may be a sign of poor asthma control.

Symptom controllers:

Symptom controllers are used for people who still get asthma symptoms even when they use their preventer medication as prescribed. They relax airways more slowly than relievers and should not be used for first-aid during an asthma attack.

Combination medications:

Combination medications are a combination of a preventer and a symptom controller in the same inhaler.

Recognising a sever attack

An asthma attack can develop over anything from a few minutes to a few days. Signs of a severe asthma attack include:

Shortness of breath

Severe chest tightness

Being unable to speak more than one or two words per breath

Distress

Little or no improvement after using reliever medication

Sucking in of the throat and ribs

Blue colour around the lips

If an asthma sufferer has any of these signs call an ambulance on 000 straight away and state that the person is having an asthma attack. Follow the four step asthma emergency plan:

Sit the person upright and reassure them

Give four puffs of reliever inhaler, preferably using a spacer device. Give one puff at a time and ask the person to take four breaths from the spacer after each puff of medication.

Use a person's own inhaler if possible.

Wait four minutes

If there is little or no improvement, repeat steps two and three. If there is still little or no improvement ensure than an ambulance has been called. Repeat steps two and three while waiting.

How to best manage asthma?

People with asthma are encouraged to manage the asthma themselves. The Asthma 3+ Visit Plan involves a program of three visits to a GP to help the patient take control of their asthma. Sometimes an extra visit may be needed.

During these visits the GP will:

Fully assess how severe the asthma is

Develop a written asthma plan to follow

Provide the patient with information and education

Review how well the medications are working.

After the initial three visits over a period of four months, the patient should only need to see the doctor about every three to six months.

Asthma self care

Do not ignore the symptoms of asthma

Identify and try to avoid trigger factors

Keep using a preventer even when you feel well. Refer to your Asthma Action Plan or doctor to decrease the dose when your asthma is under control and increase the dose when symptoms increase or you know exposure to triggers is likely

Always carry a reliever with you

Exercise regularly and eat a healthy diet. Always warm up and, if necessary, use your reliever or symptom controller as prescribed before exercise

If you smoke, quit smoking (see the Smoking section)

Check with your doctor or pharmacist before stopping or starting any medication including over-the-counter medications and herbal products

Just because you have asthma does not mean you cannot:

Exercise

Play Sport

Be active

Depression

Depression is much more than feeling sad or in a low mood after a disappointing or distressing experience. Depression is a serious mental and physical illness that changes how a person thinks, feels and behaves. People with depression need professional help and sometimes medicines to get better.

Depression is thought to be at least partly due to a chemical imbalance in the brain. It is an illness that anyone can develop at any age but it is more common in people with a family history of depression.

It is often a combination of factors that triggers an episode of depression.

Signs and symptoms

Symptoms can involve thoughts, feelings and physical signs and include:

Feeling deeply sad, hopeless, in despair

Loss of interest and enjoyment in life

Difficulty sleeping or sleeping too much

Major appetite and weight changes

Tiredness, loss of energy

Trouble thinking, concentrating and making decision

Feeling helpless, worthless, guilt

Feeling restless, irritable, agitated

Feeling very fragile and on edge

Thoughts of suicide or death

Problems with sexual function or loss of interest in sex

Headaches and muscle pains

If you have any of these symptoms, talk to your doctor. Parents are encouraged to be alert to these symptoms in teenagers.

If low feelings become overwhelming or last for more than two weeks and are associated with other symptoms of depression, consult a doctor.

Feelings of hopelessness or despair can lead to thoughts of suicide and self harm. These thoughts are serious and dangerous. Seek help if you experience these.

Treatment

Treatment often involves several different strategies depending on the type and severity of the depression.

Talking and support

Talking is often the first step in managing depression and counselling and behaviour therapies are important treatments. Local doctors, psychiatrists, psychologists and some counsellors can help with these therapies.

Medicines

Antidepressant prescription medicines can correct the balance of chemicals in the brain. There are many types of antidepressants and a person may need to try several antidepressants before finding one that suits them.

Antidepressant Medicines

Must be prescribed by a doctor

Relieve the physical symptoms of depression

Are not addictive

Are most effective when combined with counselling therapy

Make take 6-8 weeks to work, although some people see benefits sooner

May affect alertness and may cause drowsiness

Can interact with other medicines, including non-prescription and complementary medicines - ask a doctor or pharmacist

Alcohol and certain foods must be avoided while taking some antidepressant medicines

Need to be taken regularly and must NOT be stopped suddenly. Antidepressants should be stopped gradually with a doctor's supervision.

Self Care

Learn about depression and its treatmen

Ask for help if you need it. Depression is an illness not a weakness

Some people find it helps to write down their thoughts and feelings. Try keeping a diary

Let family and friends know how you are feeling. Even though they may not fully understand what you're going through, they may be able to give some extra support.

Learn techniques to relax your body and mind

Eat a healthy, balanced diet

Exercise regularly to help improve your mood and physical health

Look after yourself. Do some things that you enjoy.

Getting help

There are many organisations that provide help and support for people with depression as well as their families and friends.

Diabetes

Diabetes occurs when there is too much glucose in the blood. Insulin is a hormone made in the pancreas that allows glucose to move from the blood into the cells where it is used to produce energy. In diabetes, either the pancreas stops producing insulin (type 1 diabetes) or the pancreas does not produce enough insulin and the body does not respond properly to insulin (type 2 diabetes).

Type 2 Diabetes

People with type 2 diabetes are more likely to have high blood pressure and cholesterol and be overweight

Develops gradually

Can often be controlled with diet and exercise, but sometimes tablets and then later, insulin may be required.

Signs and Symptoms

These may include:

Passing more urine

Increased thirst and / or hunger

Tiredness - loss of energy

Weight loss (type 1)

Itching and skin infections (e.g. thrush)

Blurred vision

Slow-healing wounds

Tingling and numbness in the feet.

People with type 2 diabetes may only notice symptoms after blood glucose levels have been high for many years.

Risk factors for diabetes

More than 500,000 Australians have type 2 diabetes and do not know it. Take the tick test below. If you tick more than one of the boxes then you are at risk of diabetes. Take this card to your doctor and ask to be tested.

I am over 45 and have high blood pressure

I am over 45 and am overweight

I am over 45 and have a family members with diabetes

I am over 55

I am over 55

I had high blood sugar levels while I was pregnant

I have had a borderline high blood sugar test

I have polycystic ovary syndrome and am pregnant

I am over 35 and am an Aboriginal or Torres Strait Islander, a Pacific Islander, of Chinese cultural origin or from the Indian sub-continent

If you are at risk of type 2 diabetes, don't rely on the presence of symptoms to know if diabetes has developed. Be tested annually to detect diabetes early. You may have diabetes without feeling any symptoms.

Effects of diabetes

If diabetes is not well controlled, blood vessels, nerves and other body organs may be damaged. This may cause complications such as:

Loss of eyesight

Kidney damage

Heart disease, stroke

Foot problems and leg ulcers

Poor blood flow

Infections

Impotence in men

Managing diabetes

The aim of diabetes management is to maintain blood glucose levels as close to normal as possible (4-8mmol/L).

A good management plan is important and should be designed in conjunction with a doctor.

Regular testing of blood glucose levels at home can monitor diabetes control. There is a variety of blood glucose monitors available.

Home blood-ketone testing for type 1 diabetics during times of illness or stress can signal an impending ketoacidosis emergency. Blood testing is more accurate than urine testing.

Some medicines can affect control of blood glucose. Always check with a doctor or pharmacist before taking anything new.

Contacts:

Heart Condition

Heart disease if the largest single cause of death in Australia. Regular exercise reduces the risk of heart disease by lowering blood pressure and blood cholesterol and helping weight control. A combination of healthy eating and regular exercise gives even greater protection against heart disease.

How much exercise?

The Heart Foundation recommends at least 30 minutes of moderate intensity exercise on all or most days of the week. Moderate intensity effort exercise involves some effort e.g. brisk walking, swimming, cycling, dancing, mowing the lawn, digging the garden.

Benefits of exercise

Lower blood pressure and blood cholesterol

Better weight control

Less risk of heart disease

Stronger and healthier bones, muscles and joints

Less risk or better control of diabetes

Less risk of colon cancer

Increased feelings of well-being, less stress, less anxiety or depression

More energy

Better sleep

Important

Get advice from a doctor before starting an exercise program if you:

Have or think you have, heart disease

Have a close relative with heart disease

Are overweight

Are a male over 35 years old or a female over 45 years old and do not exercise

Have had a stroke

Have high blood pressure

Have any medical conditions, past or present, which may interfere with exercising

Smoke - think about quitting

Are pregnant

If exercise causes breathlessness, pains in the chest or your heart to beat too fast, stop straight away and see a doctor.

Getting started

It is never too late to start or increase exercise and every little bit helps

Self Care

Spend at least 30 minutes a day walking briskly. Go to different places to make it interesting

Relax while you walk and breathe deeply

Replace fluids during and after exercise by drinking water or fruit juice. Avoid drinks such as coffee, tea or alcohol as these can cause your body to lose fluids. You should drink at least 2 litres (8 glasses) of water per day

Wear comfortable clothing and warm up and stretch before and after exercise

Make a realistic plan and try to stick to it. If it goes wrong, think what went wrong and adjust your plan to try again

Reward your self in a healthy way

Eat healthy and nutritious food

Disclaimer

These programs provide general guidelines only and assumes no pre existing medical conditions. This program does not take into account any specific medical, physical or individual training advice requirements. Please note it is not advisable to begin an exercise program whilst you are pregnant; please consult your physician for advice.

The information, facts, and opinions provided are no substitute for professional advice. Always consult your physician for any medical advice, diagnosis, or treatment and before undertaking an exercise or dietary program.

Please understand that you are solely responsible for your health selection and performance during the program, and do so at your own risk. In no way is Sue Stanley or Sue Stanley consultants or advisors who have contributed to the program are responsible for any kind of injuries or health problems that might occur due to the use of this program or the advice contained in it.